Office of Workers' Compensation Programs (OWCP)
Division of Federal Employees' Compensation (DFEC)
§8119. Notice of injury or death
An employee injured in the performance of his duty, or someone on his behalf, shall give notice thereof. Notice of a death believed to be related to the employment shall be given by an eligible beneficiary specified in section 8133 of this title, or someone on his behalf. A notice of injury or death shall--
(a) be given within 30 days after the injury or death;
(b) be given to the immediate superior of the employee by personal delivery or by depositing it in the mail properly stamped and addressed;
(c) be in writing;
(d) state the name and address of the employee;
(e) state the year, month, day, and hour when and the particular locality where the injury or death occurred;
(f) state the cause and nature of the injury, or, in the case of death, the employment factors believed to be the cause; and
(g) be signed by and contain the address of the individual giving the notice.
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